Self-Management of Injection-Related Wounds Among Injecting Drug Users

Roose, Robert J.; Hayashi, A. Seiji; Cunningham, Chinazo O.

doi:10.1080/10550880802545200

Cited by 18 publications

(15 citation statements)

References 18 publications

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“…The late (day 7 postinjury) augmented production of inflammatory cytokines like TNF-α, IFN-γ, IL-6, and TGF-β observed in METH-treated groups promotes the activation of MMP-2 via NF-κB signaling in dermal fibroblasts embedded in collagen type I ( 39 ). Our study is important because self-management of injection-related wounds is common among injection drug users (IDUs) ( 11 ). Specifically, IDUs are more likely to engage in potentially harmful self-management behaviors, increasing their susceptibility to MRSA infections due to a combination of aggressive management of their wounds and an underlying slow healing rate.…”

Section: Discussionmentioning

confidence: 99%

“…S. aureus , including community-acquired MRSA, is the most important bacterial pathogen in skin and soft tissue infections (SSTI) among drug users ( 8 – 10 ). SSTI incidence is difficult to assess among drug users because such infections are often self-treated ( 11 ). However, crystal METH injection is associated with frequent visits to the ER due to abscesses, cellulitis, and other skin infections ( 12 ).…”

Section: Introductionmentioning

confidence: 99%

“…METH is associated with several socioeconomic and behavioral risk factors that may predispose individuals to MRSA SSTI ( 11 ). Notably, even noninjection use is associated with MRSA SSTI, as smoking METH is an independent risk factor for MRSA, including primary skin abscesses and invasive infections ( 13 , 14 ).…”

Section: Introductionmentioning

confidence: 99%

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Methamphetamine Alters the Antimicrobial Efficacy of Phagocytic Cells during Methicillin-Resistant Staphylococcus aureus Skin Infection

Mihu

Roman-Sosa

Varshney

et al. 2015

mBio

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Methamphetamine (METH) is a major drug of abuse in the United States and worldwide. Furthermore, Staphylococcus aureus infections and METH use are coemerging public health problems. S. aureus is the single most important bacterial pathogen in infections among injection drug users, with skin and soft tissue infections (SSTI) being extremely common. Notably, the incidence of SSTI, especially in drug users, is difficult to estimate because such infections are often self-treated. Although there is substantial information on the behavioral and cognitive defects caused by METH in drug users, there is a dearth of knowledge regarding its impact on bacterial infections and immunity. Therefore, we hypothesized that METH exacerbates S. aureus skin infection. Using a murine model of METH administration and wound infection, we demonstrated that METH reduces wound healing and facilitates host-mediated collagen degradation by increased expression and production of matrix metalloproteinase-2 (MMP-2). Additionally, we found that METH induces S. aureus biofilm formation and leads to detrimental effects on the functions of human and murine phagocytic cells, enhancing susceptibility to S. aureus infection. Our findings provide empirical evidence of the adverse impact of METH use on the antimicrobial efficacy of the cells that comprise innate immunity, the initial host response to combat microbial infection.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Methamphetamine Alters the Antimicrobial Efficacy of Phagocytic Cells during Methicillin-Resistant Staphylococcus aureus Skin Infection

Mihu

Roman-Sosa

Varshney

et al. 2015

mBio

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“…Skin abscesses, the most common bacterial infection, are initially surface infections that can cause extreme pain. Although IDUs often attempt to self-treat when they contract an abscess (Binswanger et al, 2000; Roose et al, 2009), abscesses can develop into life-threatening infections that can lead to hospitalization requiring extensive IV antibiotics, the delivery of which is complicated in persons without adequate venous access. Greater numbers of methicillin-resistant Staphylococcus aureus (MRSA) and polymicrobial bacterial infections are being observed among IDUs (Lloyd-Smith et al, 2010; Hsieh et al, 2008; Al-Rawahi et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

Skin and needle hygiene intervention for injection drug users: Results from a randomized, controlled Stage I pilot trial

Phillips

Stein

Anderson

et al. 2012

Journal of Substance Abuse Treatment

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A new skin and needle hygiene intervention, designed to reduce high-risk injection practices associated with bacterial and viral infections, was tested in a pilot, randomized controlled trial. Participants included 48 active heroin injectors recruited through street outreach and randomized to either the two-session intervention or an assessment-only condition (AO) and followed for six months. The primary outcome was skin and needle cleaning behavioral skills measured by videotaped demonstration. Secondary outcomes were high-risk injection practices, intramuscular injection, and bacterial infections. Intervention participants had greater improvements on the skin (d = 1.00) and needle cleaning demonstrations (d = .52) and larger reductions in high-risk injection practices (d = .32) and intramuscular injection (d = .29), with a lower incidence rate of bacterial infections (HR = .80), at 6-months compared to AO. The new intervention appears feasible and promising as a brief intervention to reduce bacterial and viral risks associated with drug injection.

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“…Injecting drug users in one small quantitative study conducted in France were typically younger; predominantly male; and usually treated abscesses, infected skin wounds and cellulitis . Self‐treatment is a common practice for injecting drug users, performed by 94% of participants in another, larger qualitative study conducted in the USA . Injecting drug users typically manage their wounds independently, a very large quantitative study in Mexico finding that only 12% of participants sought medical treatment from a clinic or hospital .…”

Section: Introductionmentioning

confidence: 99%

How and why patients self‐treat chronic wounds

Kapp

Santamaria

2017

International Wound Journal

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The aim of this study was to investigate how people self-treat chronic wounds, why they self-treat and the assistance and support that they receive. The increasing emphasis on self-management of chronic conditions, the potential benefits of self-treatment to the health care consumer and competing demands on health care funding are good reasons to investigate self-treatment of chronic wounds as we have little data on this group of individuals. A survey study was conducted in Australia. A non-random sample of 100 participants was recruited. Participants were aged 18 years or older and currently or previously had a chronic wound that they self-treated. All participants completed one survey. Data analysis involved descriptive statistics. The sample was, on average, 64·6 years of age; half was female (n = 50, 50%), and the majority had a lower leg wound (n = 80, 80·0%). The sample scored 33·9/40 on the Generalized Self-efficacy Scale and 68/100 on the Medical Outcomes Social Support Scale. The majority of the 89 participants who used a wound dressing used a product that targeted bacteria (n = 59, 66.3%). The two most commonly selected reasons for self-treating were 'to be independent' (n = 58, 58·0%) and 'to do the treatment at a time that suited' (n = 55, 56·0%). Less than one quarter of participants reported being supervised regularly during the wound episode (n = 22, 22%), and few (n = 6, 6·0%) reported having received education and training to support their self-treatment. Self-treaters of chronic wounds may benefit from standardised education and closer professional supervision to optimise self-treatment practices. Efforts to improve patient satisfaction with professional care are required to promote a shared-care model when self-treating and to optimise patient outcomes.

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Self-Management of Injection-Related Wounds Among Injecting Drug Users

Cited by 18 publications

References 18 publications

Methamphetamine Alters the Antimicrobial Efficacy of Phagocytic Cells during Methicillin-Resistant Staphylococcus aureus Skin Infection

Methamphetamine Alters the Antimicrobial Efficacy of Phagocytic Cells during Methicillin-Resistant Staphylococcus aureus Skin Infection

Skin and needle hygiene intervention for injection drug users: Results from a randomized, controlled Stage I pilot trial

How and why patients self‐treat chronic wounds

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